Combivent

Why is this drug prescribed: Combivent is prescribed for people with chronic obstructive pulmonary disease (COPD) if they are already taking one airway-opening medication and need another. The product's two active ingredients act in distinctly different ways. Ipratropium quells airway-closing spasms in the bronchial walls. Albuterol relaxes the muscles in the walls, permitting them to expand. When used together, the two ingredients provide more relief than either can do alone.
Combivent is supplied in an aerosol canister for use only with the special Combivent mouthpiece.

Most important fact about this drug: Overuse of this product can be fatal. Do not increase the dose or frequency without your doctor's okay. If you find that Combivent is becoming less effective, that your symptoms are getting worse, or that you need the product more frequently than usual, see your doctor immediately.

How should you take this medication: Remove the orange protective cap from the mouthpiece and shake the canister well. If you are starting a new canister, or if more than 24 hours have passed since your last dose, test-spray the canister 3 times. For best results, make sure the canister is at room temperature. Do not use near an open flame.
Exhale deeply through your mouth, then close your lips around the mouthpiece. Keep your eyes closed to protect them against an accidental spray.
Inhale slowly through the mouth, and at the same time press down once on the canister's base.
Hold your breath for 10 seconds, then remove the mouthpiece from your lips and exhale slowly.
Wait 2 minutes, shake the canister again, and repeat.
The mouthpiece can be washed with soap and hot water. Rinse it and dry thoroughly. Keep the mouthpiece capped when not in use. Count the number of sprays and discard each canister after 200 sprays; canisters may fail to deliver the proper dose if used for more than that amount.
--If you miss a dose...
Take the forgotten dose as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and return to your regular schedule. Do not take two doses at once.
--Storage instructions...
Store at room temperature. Protect from heat; temperatures of 120 degrees Fahrenheit can cause the canister to burst. Do not puncture the canister or discard it in an incinerator. Protect from high humidity.

Why should this drug not be prescribed: You'll have to avoid Combivent if either of its ingredients have ever given you an allergic reaction. Avoid it, too, if you've had a reaction to atropine-containing drugs such as Donnatal, or if you are allergic to peanuts, soybeans, or soy lecithin.

Special warnings about this medication: Instead of opening the airways, Combivent sometimes causes them to close. This reaction--which can be life-threatening--is most likely to occur after the first use of a new canister. If you suffer severe breathing difficulties after a dose of Combivent, stop using it and see your doctor immediately.
The albuterol in Combivent has been known to raise heart rate and blood pressure. It can also cause changes in heart rhythm. If you have a weak heart, an irregular heartbeat, high blood pressure, or any other heart problem, you'll need to use Combivent with caution. If it triggers heart-related symptoms, check with your doctor at once. The product may have to be discontinued.
A severe allergic reaction can follow the first dose of Combivent. Possible symptoms include swelling of the face, mouth, or throat; hives, skin rash, breathing difficulties, or even collapse. Seek emergency care immediately if these symptoms occur.
The ipratropium in Combivent can aggravate glaucoma (high pressure in the eye), prostate enlargement, and urinary difficulties. The albuterol it contains can cause problems for people with epilepsy, diabetes, or an overactive thyroid. Use Combivent with caution if you have any of these conditions.
If the Combivent aerosol gets in your eyes, it can cause eye pain or discomfort, blurred vision, visual halos, colored images, or high pressure in the eye. Check with your doctor immediately if you develop any of these problems.

Possible food and drug interactions when taking this medication: Combivent can be taken with other drugs for COPD, but you should use other inhaled medications only as directed by your doctor. If Combivent is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Combivent with the following:
Airway-opening drugs such as Advair, Alupent, Brethine, Proventil, Ventolin, and Xopenex
Drugs classified as beta blockers, including Inderal, Sectral, and Tenormin
Drugs classified as monoamine oxidase inhibitors, such as the antidepressants Nardil and Parnate
Spasm-quelling medications such as Cogentin, Donnatal, and Levsin
Water pills (diuretics) such as Lasix and HydroDIURIL
Tricyclic antidepressants such as Etrafon, Norpramin, Sinequan, and Vivactil

Special information if you are pregnant or breastfeeding: The effects of Combivent during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately.
It's not known whether the components of Combivent appear in breast milk, but it's considered best to avoid use of the drug if you are breastfeeding.

Recommended dosage: The usual dosage is 2 inhalations 4 times a day. You can take additional inhalations as required up to a total of 12 inhalations each 24 hours.

Overdosage: An overdose of Combivent can be fatal. If you suspect an overdose, seek medical attention immediately.
Symptoms of Combivent overdose may include:
Chest pain (angina), high blood pressure, rapid heartbeat, cardiac arrest